07100117 CITY OF CUPERTINO � ,I (`� `
BU[LDING DIVISION pERNIIT 4���'7A��� ��`�:�����• '
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BUILDING ADDRESS: PERMIT NO.
10201 TORRE AVE MEADE CONSTRUCTION GROUP 07100117 .
VER'S NAME: �— �� �� DA �
SYMANTEC 645 RI��ER OAKS PKWY � 11/05/2007
PHONE: SANITARY NO. CONTROL NO.
(408)3�1-645�
ARCHI7'EC[7ENGINEER: BUILDINC PERMITINFO
BLDG ELECT PLUMB MECH
� � � 0
� o p UCENSED CONTRACfOR'S DECLARAT[ON
� 1 hc�cby af[icm tlut 1 am liccnscd unJcr provisions o[ CAaptcr 9(commencing Job Description
� z wi�h Sccuon 70O0) of Division 3 of thc Business �nd Profcssions Codc ana my �iccnsc is TEV I S I C N— T. I. REMOVE 3 RD F LR WOI�&MEN S HOWER FROM
"� a in full Corce and e[fect
�� r y Z, LicenscClus ��.� SCOPE C'F WORK—ORIG PEKMIT #07060103
± �„� Dam Con�ractor
g ARCHI'i'ECI'S DECLARATION
� ot 1 undcrstand my plans shall t�c used u public rccorda
�qU
4 O y Liccnsed Rufcssioaal �
n y � OWNER-BUILDER DECLARATION
� <� t hcrcby affirm ihat I am raccmpt Gum 1hc Camractor's Liccnsc Law for �hc
i p O following rcaton. (SccGon 7031.5, Business and ProCc.ctiont Calc: My city or county
K m ° �i which requires a pcmiit to consuuct, aNcr, improvc, dcmolish, or �epair any swcturc
� Z� prior w i�s iuuancc, alsu rcquims thc applicant for such permit to filc a signed sulemeni
_< �hal Ac is licenscd pucsuan� to ihc pmvisions of ihc Conuactur's Licc�sc Law (CAaptcr 9 Sq. Ft. Floor Area $ O Valuation
y F� (commencing with Scction 7000) of Division 3 of �hc Busincss and Profcssiona Cadc) or
y �.. Ihat he is exempt thetefrom and the batis for the ailegcd exemption. Any violauon o(
Section 7031.5 by a�ry applicant for a permit subjecu �he applicant to a civil penalty oC Number Occupancy Type
not more �han fiw hundred dollars (5500). 3 6 9 410 C 5��
0 1, as owner of tlie propecty, or my empioyces with wages u �he'v solc compenastion,
will do the work, and ihe swcwrc is not intended or ofCeced for salc (Sec. 7044. Husiness Re uired Ins ections
end Professions Code: The Contrutors License Law does not apply to an owne� of 9 P
property who builds or improves thercon, and who does such wark himultor through hu
own emplayccs, providcd that such improvements are not intended or ot[ered for sala If,
however, the building or impmvement ia sold within one year oC camplcuon, ihe owner-
builder will have the burden oC proving �at he did not build or impcovc for purpose of
sakJ.
❑ as awner o[ the property, am exclusively conuuting wilh licensed rnntrac�ors to
uuct the projea (Sec. 7044. Business and Professions Code:)1Le ConUSCwr's Li-
ccnse C.aw dacs oo� apply w an ownu of property who builds or improves theceon, and .
who convacis Cor such projec�s with a conuaaor(s) licensed pursuant w ihe Convactor's
License Caw.
lamex ptun .B�PCfor�
,�vnor / ,-' D i
ORKER M �S N17�CCLARA170N
1 hereby adirm unde � nalry o[ pe ' one a[ �he follawing declantions:
❑ I hsve and will mainuin a Cenifica f nsent to self-insum for Workcr's Compem
sation, u provided for by Section 37 tlx Labor Code, for the performanx of thc
wark for whith Ihis pem�it is issucd.
❑ 1 have and will main�sin Worker's Compensation Insurana, u required 6y Scction
3700 of �Ae Labor Codc, for thc pedortnantt of the work for w6ich this permit is issued.
My Worke�s Compensation Insurance csrticr and Policy number arc:
Cartier. Policy No.:
CER7'IF7CATE OF EXEMPf'[ON FROM W ORKERS'
COMPENSATION INSURANCE •
(fhis seclian need not bc complctcd if �he pem�it is far onc hundred dallacs (S I00)
oc Icu) •
1 cenify tlwt in thc performaocc r hich ihis permit is issucd. 1 shall not
employ any persan in any m ome subject Workcrs' � pen '
Laws of Califort�ia.
Applicant
N077CE TO APPL.1 . If, afkr making �h' cni[ica�c of mp on, you should
baome subjxt to Ihc Worker's Compensation visions ol' �hc 1ar Codc, you muu
, O forthwith comply with such provisions or �his permi� shall qE cmcd ccvokcd.
�
z"'' CONSTRUCTION LENDING AG CY
[— � 1 hc�chy alTirm Uut there is a consuucdan knding agc�xy for thc perfortnance of
�i � ihe work fur which ihis pumit is iuued (Scc. 3097, Civ. C.)
� A Lendcr's Namc •
a z Lcnders Address
V 0 1 cenify �hat I havc read this application and siaic �hu �he above infom�auun is
w�' cortca I agra to comply with all rity and county oNinances and sute laws celadng w
0 U building consuuetion, and he�eby authorim mprescmativcs of this ciry w cn�cr upon ihc
W ahovc-mentioned propcny for inspecuon pu�posea
(Wc) ayee to save, indcmnify �nd kecp harmless the Ciry o[ Cupertino against
�,, � Iiabiliva, judgmcnls, cosls d eacpenses which may in any way acctuc against said City
� T
V z in conseq oC t ihis permi�. Date �/ f ���
►+ APPLIC UND ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR L NS, i , �'°,,, f�
' .., ,. J U l Re-roofs �/
Sig uro af ApphanVCo tor Datc
H OUS A ALS D[SCLOSURE Type of R.00f
�11 thc appli futurc i ng accupant storc or handlc ha•rardous matcrial
kfincd 6y the Cupe no Municipal Codc. Chaptcr 9.12, and che Heal�h and Safcty
.,�, s�o� zssszce>� All roofs shall be inspected prior to any roofing material being installed.
❑Yu ❑No
Will thc applicant or Cuture building accupant usc cyuipmcnt or dcvices which
If a roof is installed without first obtaining an inspection, I agree to remove
cmil harardous air caflaminants at ekfincd Ay �hc Bay Area Air Quality Managcmen� all new rr aterials for inspeccion.
District?
❑Ycs �Nu
1 havc rcad ifie hv maicrials requiremcnu undcr Chaptcr 6.95 of �hc Califor-
nia Hcalth & Safcty C 'ons 25505, 25533 arx125534.1 undcrsund U�az iC ihc 6uilding
docs not rtcnUy havc nan4 � il is my rcsponsibilily to notiCy �he accupsnt nf �hc
rcquirc cn w" h � ri jo' uarkco(aC '�a � a� ��r. Signature of Applicant Date
/�, -''
Owncr or au� hori�c d ascn o„� All roof coverings to be Class "B" or better